Transgender people are at a significantly higher risk of having an eating disorder than their cisgender counterparts, according to a new study from researchers at Washington University in St. Louis.

Using data from the American College Health Association-National College Health Assessment II, a national survey of the health of college students, the study provides some of the first insights into how eating disorders impact the transgender community. Previous research has shown that gay and bi men have a significantly higher risk of eating disorders, rivaling even the rates for heterosexual women, but there has not been sufficient evidence available to draw conclusions about the transgender community.

The new study confirms that trans people face an even more alarming rate of eating disorders than even gay and bi men. About 16 percent of trans respondents reported that they had been diagnosed with an eating disorder in the past year. The next highest rate was among cisgender men who were unsure of their sexuality, who reported rates at 3.66 percent. The lowest rate was among straight cis men — about half a percent.

Researchers point to numerous reasons the eating disorder levels might be so high for transgender people. Other studies that assessed people with “conflicted gender identity” suggested that individuals used eating behaviors to suppress or accentuate particular gendered features, such as weight loss for transgender women who may try to conform to feminine ideals of slimness and attractiveness.

Another possibility is the impact of minority stress, the discrimination, violence, and stigma transgender people experience. “Minority stress has been identified as a potential factor in the association between transgender identity and disordered eating,” the researchers write. “Among lesbian, gay, and bisexual individuals, a strong link has been found between higher levels of minority stress and poorer mental health outcomes. The same mechanisms are likely at play in transgender individuals, who may be exposed to substantial amounts of discrimination, both on an interpersonal and societal level.”

Transgender people may also have reported higher rates of diagnosis because they are simply more likely to have been in contact with a mental health professionals. Minority stress can have many different consequences, so a trans person could end up being diagnosed with an eating disorder after seeking treatment for something else, like depression. Plus, transgender people seeking to transition need to see therapists to be prescribed the necessary treatments. The researchers point out that the National Transgender Discrimination Survey found that 75 percent of transgender people had received counseling on their gender identity compared to just 18 percent of the general public.

The researchers describe their findings as “an important starting place for future investigations.” They acknowledge that it has many limitations, such as the inability to discern between transgender men, transgender women, and gender nonconforming people or to distinguish between the sexual orientation of those transgender respondents. “Longitudinal studies with more comprehensive assessments of disordered eating are needed to identify factors contributing to relationships among gender identity, sexual orientation, and eating-related pathology.”

Researching transgender people is difficult because of both their small numbers and invisibility. The National Transgender Discrimination Survey conducted in 2011 was the largest collection of information about the lives of transgender people, including their experiences in health care settings, but it did not ask about specific health concerns like eating disorders. Its next incarnation, now known as the U.S. Trans Survey, is set to launch later this month and will likely provide even more significant context for other research into specific trans health outcomes.